Very early this morning, I was sent to perform a procedure called bloodletting on a young girl suffering from cholera and I could not do it.
Perhaps it would be more truthful to say I refused to do it.
I have come to believe that bloodletting, the taking of blood from a patient, is not only without benefit to a person with cholera, but is indeed harmful.
My name is Mathew Brogan and I am a doctor in the Indian Medical Service, which serves the British Empire in India.
The year is 1875 and I am stationed in Calcutta.
Before I came to India, I graduated from the medical school at the University of Edinburgh in Scotland after two years of study.
My education included physiology, anatomy, surgery, pharmacy, pathology, and the diseases of men, women, and children.
But nothing I was taught prepared me for the cholera epidemics that are so prevalent in Europe and Asia these days.
Hundreds of thousands of people have died from this disease, which causes abdominal distress and results in the loss of large amounts of body fluids.
There is no cure for cholera as of yet; many remedies have been tried, but nothing works, least of all bloodletting.
Yesterday my colleague Doctor McGregor and I were called to a house where the whole family was sick with the disease.
The air was filled with the stench of vomit and feces, and the house was full of bodies.
It was hard to tell who was alive and who was dead.
According to the neighbors, the family had just returned from a pilgrimage to the Temple of Jagannatha in the town of Puri.
This fact reminded me that large gatherings of people tend to trigger cholera outbreaks, but the reason why is unclear.
We walked past an older man lying on a cot outside the front door.
It was obvious that nothing could be done for him; his eyes were deep in their sockets and his skin was blue.
The sick man resembled a raisin—a dried fruit that has lost all its moisture.
I kneeled next to two children inside the house who were also near death and examined them.
A woman, probably their mother, was nearby; she was vomiting and had severe diarrhea.
McGregor instructed me to bleed her, so I used my spring lancet, a very efficient tool.
But I had a difficult time piercing her shriveled skin.
The blood, when it finally emerged, was dark, thick, and gummy.
How could such thick blood flow through the heart?
The woman died within the hour, and I could only ask myself, why did we try to take more fluid from a body that was already dry?
As I walked home with Dr. McGregor, I was troubled and said to him,
"At Edinburgh, my professor, Dr. Joseph Lister, spoke of a theory proposing that a bacterium, an invisible organism, causes cholera.
Another prominent doctor supports that claim too and believes the germ is carried by dirty drinking water."
McGregor stopped and faced me. He pushed his finger into my chest.
"I've heard of those tiny germs, and I don't believe in them," he said.
"Nobody believes in them! It's just bad air, Brogan.
Besides cholera usually affects only the ignorant and the poor."
I wondered to myself how air breathed by the poor would be different than air breathed by the wealthy.
It is true that the poor get the disease more than the rich,
but the reason for that could be the conditions in which they live—the crowding, the lack of sanitation.
Lister's germs thrive in filth, so perhaps the cholera germ, whatever it is, thrives in filth as well.
"That woman had no fluids left," I said to McGregor.
"Her blood barely flowed. Perhaps we should not have taken her blood."
But McGregor insisted that he had been treating cholera since 1853, and that bloodletting was an appropriate treatment for the disease.
Despite McGregor's opinion, when I was called to that young girl's side this morning, I decided to try something different.
Her face looked haggard, and she complained of stomach cramps and occasional diarrhea.
When I informed her it was the first stages of cholera, she seemed resigned to her death.
We often use a mustard plaster to treat cholera because it is believed that the plaster eases a patient's pain and cramping.
A mustard plaster is made with a paste of dry mustard, a bit of flour, and an egg, which is then spread on a cloth and placed on the abdomen or back.
Once placed on the patient's skin, the mustard plaster becomes hot and draws the body's blood to that area.
But this time I decided against that remedy and settled on opium, a medicine I know to be effective in relieving diarrhea and cramps.
I also offered her sips of cool ginger tea that I brought with me.
Just in case the new theories are right and the disease is indeed carried in contaminated water, I asked her mother to boil any water they drink.
I checked on her at noon, in between seeing other patients.
Even though she had started vomiting, she was not becoming shriveled like so many other victims.
I instructed her mother to keep wet compresses on her forehead (using clean, cooled water only)
and to continue giving her daughter as many sips of ginger tea as she would tolerate.
"She needs to replace the fluids she's lost," I admonished.
In the evening I checked on my patient again.
She was feverish, and although her mother was concerned, I was gratified.
Fever is a symptom that tells the doctor the body is fighting back against an infectious disease.
After convincing them both that she would recover, I headed home.
One patient is not sufficient proof, but I am glad I did not bleed this patient.
I will continue to experiment with other kinds of treatments, and someday I hope to understand what causes cholera.
These are exciting times to be a doctor, and I look forward to finding a cure for this devastating disease.